General practitioners, private hospitals, medical centres, pathology labs and diagnostic imaging centres will all be expected to access patient files held in the $500 million PCEHR system when it commences next July, but they will bear the full brunt of fines up to $66,000 for each "inappropriate access" by a doctor or other employee.
Meanwhile, public hospitals and state-based facilities will have Crown immunity from prosecution over data breach offences.
E-health experts have warned that the authentication technology needed to guarantee security does not yet exist, while organisations will be unable to adequately monitor access by individuals working within their facilities.
AushealthIT blogger David More said healthcare organisations would be wary of signing up for a system that threatened such large penalties, especially as the National Authentication Service for Health was still under development.
Only when the NASH was finished and implemented would it be possible to provide the promised individual authentication rather than shared non-individualised authentication based on location which was possible now.
"It’s clear an approach to providing a user-specific trail from the provider to the PCEHR system is still a work in progress," Dr More said.
"Will healthcare providers have to create and retain their own audit trails of which (authorised) user has logged on to what system using the organisation’s digital certificate and when?
"This certainly seems to pass responsibility and risk from the system operator back onto the healthcare provider."
The draft legislation states that Health department secretary Jane Halton will fill the role of PCEHR system operator upon commencement, as long-term governance arrangements -- including ongoing funding -- are yet to be thrashed out by the federal, state and territory governments.
"In my view, it’s utterly unacceptable to be creating a system containing a very wide range of sensitive information and not have the governance properly laid out, publicly discussed and agreed before it starts," Dr More said.
The Gillard government has also failed to produce uniform health privacy laws to underpin the national system, so the existing patchwork of state privacy laws will continue.
Private-sector healthcare organisations which choose to host patient data repositories as part of the system -- for example, GPs uploading to a health summary repository, or hospitals uploading to a discharge summary repository -- will also face hurdles in achieving compliance with PCEHR requirements on interoperability, privacy, integrity and long-term availability of the information.
The PCEHR infrastructure, being built by an Accenture-led consortium, will include an indexing system to locate a patient’s files across multiple repositories and separate portals to allow viewing by both doctors and patients.
Newly released Health department documents say that from July 1 next year, Australians will be able to register for a PCEHR online, through face to face channels or via the mail.
But people will first have to satisfy "the relevant identity verification processes", which are yet to be revealed.
"Once registered, individuals will be able to set up access controls, nominate representatives and register other individuals within their care," the department said.
"Individuals will also have the choice to allow Medicare claims and Pharmaceutical Benefits data to be available in their PCEHR.
"Where the capability exists, healthcare providers will also be able to start populating the PCEHR with clinical documents."
However, the government is yet to decide whether to provide financial incentives to GPs to encourage adoption of the new system.
The department said GPs participating at the three lead sites are "receiving a support payment" from their Medical Local or division of general practice.
"This compensates GPs for the required provider effort in terms of trialling systems, reporting and evaluations," it said.
The department has also conceded that the quality of data currently held by health organisations is not high, and this represents the starting point for the new e-health system.
"The PCEHR will be dependent on the quality of information created by providers, which may be of varying quality," it said.
"People registering for a PCEHR will be able to see their information in ways not easily accessible to them before, and this creates an opportunity to work in partnership with their doctors to identify poor quality information and improve their records at the source."
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Autor(en)/Author(s): Karen Dearne
Quelle/Source: Australian IT, 06.10.2011
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